High-Spatial-Resolution 3D Whole-Heart MRI T2 Mapping for Assessment of Myocarditis

TY - JOUR

T1 - High-Spatial-Resolution 3D Whole-Heart MRI T2 Mapping for Assessment of Myocarditis

AU - Bustin, Aurélien

AU - Hua, Alina

AU - Milotta, Giorgia

AU - Jaubert, Olivier

AU - Hajhosseiny, Reza

AU - Ismail, Tevfik F

AU - Botnar, René M

AU - Prieto, Claudia

N1 - Funding Information: Supported by the Engineering and Physical Sciences Research Council (EP/P032311/1, EP/P001009/1, and EP/P007619/1), British Heart Foundation (grant no. RG/20/1/34802), King’s British Heart Foundation Centre for Research Excellence (RE/18/2/34213),Wellcome Engineering and Physical Sciences Centre for Medical Engineering (NS/A000049/1), and the Department of Health through the National Institute for Health Research Cardiovascular Health Technology Cooperative and comprehensive Biomedical Research Centre awarded to Guy’s and St Thomas’s National Health Service Foundation Trust in partnership with King’s College London and King’s College Hospital National Health Service Foundation Trust. Funding Information: Supported by the Engineering and Physical Sciences Research Council (EP/P032311/1, EP/P001009/1, and EP/P007619/1), British Heart Foundation (grant no. RG/20/1/34802), King's British Heart Foundation Centre for Research Excellence (RE/18/2/34213),Wellcome Engineering and Physical Sciences Centre for Medical Engineering (NS/A000049/1), and the Department of Health through the National Institute for Health Research Cardiovascular Health Technology Cooperative and comprehensive Biomedical Research Centre awarded to Guy's and St Thomas's National Health Service Foundation Trust in partnership with King's College London and King's College Hospital National Health Service Foundation Trust. Publisher Copyright: © RSNA, 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - Background: Clinical guidelines recommend the use of established T2 mapping sequences to detect and quantify myocarditis and edema, but T2 mapping is performed in two dimensions with limited coverage and repetitive breath holds. Purpose: To assess the reproducibility of an accelerated free-breathing three-dimensional (3D) whole-heart T2 MRI mapping sequence in phantoms and participants without a history of cardiac disease and to investigate its clinical performance in participants with suspected myocarditis. Materials and Methods: Eight participants (three women, mean age, 31 years 6 4 [standard deviation]; cohort 1) without a history of cardiac disease and 25 participants (nine women, mean age, 45 years 6 17; cohort 2) with clinically suspected myocarditis underwent accelerated free-breathing 3D whole-heart T2 mapping with 100% respiratory scanning efficiency at 1.5 T. The participants were enrolled from November 2018 to August 2020. Three repeated scans were performed on 2 separate days in cohort 1. Segmental variations in T2 relaxation times of the left ventricular myocardium were assessed, and intrasession and intersession reproducibility were measured. In cohort 2, segmental myocardial T2 values, detection of focal inflammation, and map quality were compared with those obtained from clinical breath-hold two-dimensional (2D) T2 mapping. Statistical differences were assessed using the nonparametric Mann-Whitney and Kruskal-Wallis tests, whereas the paired Wilcoxon signed-rank test was used to assess subjective scores. Results: Whole-heart T2 maps were acquired in a mean time of 6 minutes 53 seconds 6 1 minute 5 seconds at 1.5 mm 3 resolution. Breath-hold 2D and free-breathing 3D T2 mapping had similar intrasession (mean T2 change of 3.2% and 2.3% for 2D and 3D, respectively) and intersession (4.8% and 4.9%, respectively) reproducibility. The two T2 mapping sequences showed similar map quality (P =.23, cohort 2). Abnormal myocardial segments were identified with confidence (score 3) in 14 of 25 participants (56%) with 3D T2 mapping and only in 10 of 25 participants (40%) with 2D T2 mapping. Conclusion: High-spatial-resolution three-dimensional (3D) whole-heart T2 mapping shows high intrasession and intersession reproducibility and helps provide T2 myocardial characterization in agreement with clinical two-dimensional reference, while enabling 3D assessment of focal disease with higher confidence.

AB - Background: Clinical guidelines recommend the use of established T2 mapping sequences to detect and quantify myocarditis and edema, but T2 mapping is performed in two dimensions with limited coverage and repetitive breath holds. Purpose: To assess the reproducibility of an accelerated free-breathing three-dimensional (3D) whole-heart T2 MRI mapping sequence in phantoms and participants without a history of cardiac disease and to investigate its clinical performance in participants with suspected myocarditis. Materials and Methods: Eight participants (three women, mean age, 31 years 6 4 [standard deviation]; cohort 1) without a history of cardiac disease and 25 participants (nine women, mean age, 45 years 6 17; cohort 2) with clinically suspected myocarditis underwent accelerated free-breathing 3D whole-heart T2 mapping with 100% respiratory scanning efficiency at 1.5 T. The participants were enrolled from November 2018 to August 2020. Three repeated scans were performed on 2 separate days in cohort 1. Segmental variations in T2 relaxation times of the left ventricular myocardium were assessed, and intrasession and intersession reproducibility were measured. In cohort 2, segmental myocardial T2 values, detection of focal inflammation, and map quality were compared with those obtained from clinical breath-hold two-dimensional (2D) T2 mapping. Statistical differences were assessed using the nonparametric Mann-Whitney and Kruskal-Wallis tests, whereas the paired Wilcoxon signed-rank test was used to assess subjective scores. Results: Whole-heart T2 maps were acquired in a mean time of 6 minutes 53 seconds 6 1 minute 5 seconds at 1.5 mm 3 resolution. Breath-hold 2D and free-breathing 3D T2 mapping had similar intrasession (mean T2 change of 3.2% and 2.3% for 2D and 3D, respectively) and intersession (4.8% and 4.9%, respectively) reproducibility. The two T2 mapping sequences showed similar map quality (P =.23, cohort 2). Abnormal myocardial segments were identified with confidence (score 3) in 14 of 25 participants (56%) with 3D T2 mapping and only in 10 of 25 participants (40%) with 2D T2 mapping. Conclusion: High-spatial-resolution three-dimensional (3D) whole-heart T2 mapping shows high intrasession and intersession reproducibility and helps provide T2 myocardial characterization in agreement with clinical two-dimensional reference, while enabling 3D assessment of focal disease with higher confidence.

UR - http://www.scopus.com/inward/record.url?scp=85101945230&partnerID=8YFLogxK

U2 - 10.1148/radiol.2021201630

DO - 10.1148/radiol.2021201630

M3 - Article

C2 - 33464179

SN - 0033-8419

VL - 298

SP - 578

EP - 586

JO - Radiology

JF - Radiology

IS - 3

ER -